V9-02: Selective clamping of the segmentary artery in robotic partial nephrectomy operation
VideoIntroductions and Objectives
A close relationship exists between the duration of partial ischemia and loss of renal function. Clamping the main artery of the kidney results in ischemia in the whole renal parachymal tissue. Selective clamping of the segmentary artery prevents global ischemia in the kidney and preserves renal functions. The aim of this video is to present a robotic partial nephrectomy operation with selective clamping of the segmentary artery.
A 45 years old male patient was diagnosed with an incidental 3 cm mass located in the upper pole of the right kidney. A robotic right partial nephrectomy operation was planned. The colon was medialized after an incision on the toldt line and retroperitoneal space was entered. The hilum of the right kidney was exposed. The renal artery and vein were dissected separately. The branch of segmental artery supplying the tumour was dissected and suspended with a vessel tape. The margins of the tumour was scored with monopolar cautery and excision line was marked. Than segmental artery was clamped with a bulldog clamp. The tumour was excised by cold scissors without using cautery in order to achieve safe surgical margins. The tumour bed was sutured with 3/0 v-lock suture. Renography was performed with sliding-weck clip technique by 2/0 vicryl. The duration of ischemia was 13 min, operative time was 105 min and blood loss was 20 cc. No postoperative complications occured and the surgical drain was removed at postoperative day 1. Patient was discharged at postoperative 48th hour.
The pathologic examination was reported clear cell renal carcinoma with negative surgical margins.
The selective clamping of the segmentary artery in robotic partial nephrectomy operation is an important and feasible technic in decreasing the ischemic trauma and the associated functional deterioration of the kidney.